Diet – a Powerful Access for Diabetes Care
Diabetes is a chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. In the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Gestational diabetes is a type of diabetes that can develop during pregnancy in women.
There is a globally agreed target to halt the rise in diabetes and obesity by 2025.
Globally, over 90% of people with diabetes have type 2 diabetes. The rise in the number of people with type 2 diabetes is driven by a complex interplay of socio-economic, demographic, environmental and genetic factors. Key contributors include urbanization, an ageing population, decreasing levels of physical activity and increasing prevalence of overweight and obesity.
Much can be done to reduce the impact of diabetes. Evidence suggests that type 2 diabetes can often be prevented, while early diagnosis and access to appropriate care for all types of diabetes can avoid or delay complications in people living with the condition.
In a nutshell, data from the IDF Diabetes Atlas 10th edition:
(IDF November 2021 )
537 million adults (20-79 years) are living with diabetes - 1 in 10. This number is predicted to rise to 643 million by 2030 and 784 million by 2045.
Over 4 in 5 (81%) adults with diabetes live in low and middleincome countries.
Diabetes is responsible for 6.7 million deaths in 2021 - 1 every 5 seconds.
Diabetes caused at least USD 966 billion dollars in health expenditure – a 316% increase over the last 15 years.
541 million adults have Impaired Glucose Tolerance (IGT), which places them at high risk of type 2 diabetes.
India, too, is seeing a stark rise in diagnoses. This is due to a complex set of factors, including genetic components and changes in eating behaviors and activity levels. Like many cultures across the world, daily life in India is changing.However, increased production of processed foods, rapid urbanization and changing lifestyles (active to sedentary) have led to a shift in dietary patterns. People are now consuming more foods high in energy, trans fats, refined carbohydrates, free sugars and salt/sodium, processed meats, ultra-processed foods. Most of them do not eat enough fruit, seeds, nuts, vegetables and other dietary fiber such as whole grains, which has led to increase in obesity and noncommunicable diseases. Stress, environmental pollution, tobacco and alcohol abuse, lack of awareness about diabetes prevention strategies are contributors that have been linked to increase in diabetes prevalence in the Indian population. Access to diabetes care and education is an important step to address this issue.
World Diabetes Day (WDD), created in 1991 by International Diabetes Federation (IDF) is the world’s largest diabetes awareness campaign reaching a global audience of over 1 billion people in more than 160 countries. It is marked every year on 14 November, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922.The theme for World Diabetes Day 2021-23 is Access to Diabetes Care– If Not Now, When?
This is, thus, the right time we qualified dietitians and nutritionists take up the theme of World Diabetes Day and disseminate diabetes education and sensitize patients, caregivers and health professionals.
Eating plan, a powerful tool for managing Diabetes and Prediabetes
"What can I eat?" is one of the first questions asked by newly diagnosed people with diabetes.
There is no such thing as a “Diabetes Diet.” Really. Making changes in the cooking methods, portion size, meal times, ingredients can make for a great meal for a person with diabetes.
According to STARCH Study (Joshi Shashank et al bmjopen, 2014), T2DM patients across India consumed 64% of energy from carbohydrates, which is higher than the recommended 60%.
While planning a meal, quantity as well as quantity of carbohydrates should be a consideration. Is it possible?
Yes! You have choices - lots of them! Many eating patterns can help you manage your diabetes, from Mediterranean to Low-carbohydrate to Vegetarian to Vegan – Whatever you choose, be sure to include lots of non-starchy vegetables, minimize added sugars and refined grains, and choose whole, minimally processed foods.
The exact make-up of a diversified, balanced and healthy diet will vary depending on individual characteristics (e.g. age, gender, lifestyle and degree of physical activity), cultural context, locally available foods and dietary customs. However, the basic principles of what constitutes a healthy diet remain the same.
Carbs are not one-size-fits-all. While there is growing evidence to show that low-carbohydrate eating patterns can benefit people with diabetes and prediabetes, there is no single definition for “low carb.” If a low carb approach is chosen, dietary fiber which is a complex carbohydrate shouldn’t be forgotten! Plan the diet in a way to minimize risks (such as hypoglycemia) and maximize success.
Weight loss works. Losing modest amounts of weight (start with 5%) can improve your blood sugars and other diabetes outcomes in both type 1 and type 2 diabetes. There are lots of ways to lose weight, from changing your diet to getting more exercise, taking medications or even surgery. A focus on lifestyle changes is the preferred starting point, but it’s important to be familiar with all possible options.
Tweaking your food choices can help reduce risk factors for complications. Food swaps are easy ways for people with diabetes to reduce their risk for cardiovascular disease and kidney disease, for example - replace foods high in saturated fat, such as butter and red meat, with foods rich in unsaturated fats, like olive oil and fish or paneer/tofu. (Reference: Key Takeaways from American Diabetes Association’s Nutrition Consensus Report ( www.diabetes.org))
The key is to a good Diabetes Diet Plan is - high in fiber, protein and healthy fats. These nutrients help keep blood sugar levels under control. It’s also important to snack on nutrient-dense foods that promote overall health. Its important to
No matter which eating pattern works best for you, it can still be hard to know where to start when it comes to building healthy meals that help you manage your blood sugar—while still being tasty.
That’s where the Diabetes Plate Method comes in. Using this method, you can create perfectly portioned meals with a healthy balance of vegetables, protein and carbohydrates—without any counting, calculating, weighing or measuring.
The size of our plate usually determines the size of the portions —about 9 inches diameter sized plate is recommended.
Diabetes Plate Method
1. Fill half your plate with non-starchy vegetables.
Non- starchy vegetables are lower in carbohydrate, so they do not raise blood sugar very much. They are also high in vitamins, minerals, and fiber, making
them an important part of a healthy diet. Filling half your plate with non starchy vegetables means you will get plenty of servings of these superfoods.Eg.: Broccoli, Cauliflower, Cabbage (green, red, napa, bokchoy, Chinese), carrots, cucumber, zucchini, eggplant (brinjal), okra (bhindi), Peppers, gourds (lauki, karela), leafy greens such as Amaranth,Spinach, Methi, mustard greens, radish leaves, beetroot leaves, Colocasia (arbi), Chenopodium album (bathua), Moringa leaves, Purslane, Water spinach (kalmi), Collard (Haak), Phodshi, mushrooms, green beans, French beans, broad beans, cluster beans, tomatoes etc.
2. Fill one quarter of your plate with lean protein foods
Foods high in protein such as fish, chicken, lean beef, soy products, and cheese are all considered “protein foods.” Proteins foods (especially those from animal sources) usually contain saturated fat, which may increase your risk of heart disease. Lean proteins are lower in fat and saturated fat, making them a healthier choice. Certain plant-based protein foods (like beans and legumes) are also high in carbohydrates.
Examples of lean protein foods include chicken, turkey, eggs, fish (salmon, cod, tuna, swordfish), shellfish (shrimp, scallops, clams, mussels, lobster), lean beef cuts, lean pork cuts, lean meats, cheese, paneer, beans, lentils, pulses, hummus, sprouts, nuts and nut butters, peanuts, tofu, tempeh, plant based meat substitutes, soya milk, Seeds like Sesame, flax, Chia, Pumpkin, Sunflower, Hemp ( Seeds also have good quality fats) etc.
3. Fill one quarter of your plate with carbohydrate foods
Foods that are higher in carbohydrate include grains (rice, ragi, wheat, bajra, jowar, oats, sooji, maida), starchy vegetables (green peas, plantain, potato, pumpkin, yam, sweet potato, squashes) beans and legumes, fruit, dried fruits, curds, and milk. These foods have the greatest effect on blood sugar.
4. Choose water or a low-calorie drink
Water is the best choice because it contains no calories or carbohydrates and has no effect on blood sugar. Other zero- or low-calorie drink options include:
• Unsweetened tea (hot or iced)
• Unsweetened coffee (hot or iced)
• Sparkling water
• Thin Buttermilk
You can still use the plate method when preparing and portioning combination foods. Just identify the different foods in the dish and think about where they would fit in the plate. For example, in a basic Indian thali where a combination of foods is eaten like Roti (carbohydrates), Subji (Vegetable), Khichadi (carbohydrates and proteins), Pulao/Biryani (carbohydrates and vegetables), and curds (proteins).
Try to prepare combination dishes with the same proportions as the plate. Include more of vegetables and dals with less of Rotis or Rice. Make sure to include the curds/lassi, green leafy vegetables with other low glycemic index vegetables too.
Different carbohydrate-containing foods affect blood sugar differently, and these effects can be quantified by measures known as the glycemic index and glycemic load.
The glycemic index (GI) assigns a numeric score to a food based on how drastically it makes your blood sugar rise. Foods are ranked on a scale of 0 to 100, with pure glucose (sugar) given a value of 100. The lower a food's glycemic index, the slower blood sugar rises after eating that food. In general, the more processed a food is, the higher its GI, and the more fiber or fat in a food, the lower it's GI. To understand a food's complete effect on blood sugar, you need to know both how quickly it makes glucose enter the bloodstream and how much glucose per serving it can deliver. A separate measure called the glycemic load (GL) does both — gives you a more accurate picture of a food's real-life impact on your blood sugar. Watermelon, for example, has a high glycemic index (80). But a serving of watermelon has so little carbohydrate that its glycemic load is only 5. (The complete list of the glycemic index and glycemic load for more than 1,000 foods can be found in the article "International tables of glycemic index and glycemic load values: 2008" by Fiona S. Atkinson, Kaye Foster-Powell, and Jennie C. Brand-Miller in the December 2008 issue of Diabetes Care, Vol. 31, number 12, pages 2281-2283.)
Summing up, we need to understand that that a lot can be done by regulating the food that we eat. Within our control, as individuals, we can influence the course of the disease by “eating smartly”. Apart from predictable diurnal control of the disease, it would make us less dependent on drugs and their
potential side-effects. Carbohydrate should be a rationed nutrient and Carbohydrate Counting should be used in managing lifestyle disorders. The bottom line is reaching and staying at a healthy weight – which is more important for your blood sugar and your overall health.
The fact that environmental factors have such a great influence on the disease is good news to us as these factors could be modified and controlled to our advantage.
" Together, we can and we will!"